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Do Accountable Care Organizations (ACOs) Help or Hinder Primary Care Physicians’ Ability to Deliver High-Quality Care?

Doctor and male patient


Already serving tens of millions of Americans, accountable care organizations (ACOs) are likely to play an even greater role in our health care system going forward. ACOs—networks of doctors and hospitals that take on financial risk for treating a group of patients—are seen by many as critical to the effort to control costs and improve quality of care. Still, their early results have been decidedly mixed.

Commonwealth Fund–supported researchers interviewed physicians and other experts to gain insights on how becoming a part of an ACO has helped or hindered efforts to deliver high-quality care.

What the Study Found

Overall, those interviewed for the study were cautiously optimistic, citing both benefits and drawbacks to joining an ACO.

Benefits reported included:

  • streamlined communications with specialists
  • access to ACO-funded staff such as nurses and care coordinators
  • support for data analysis
  • enhanced ability to deliver team-based care
  • increased prestige.

Drawbacks included:

  • added bureaucracy
  • loss of autonomy
  • referral restrictions
  • incentive or payment systems that fail to make a clean break with fee-for-service.

The most widely and strongly held belief among interviewees was that revenue derived from fee-for-service style billing needs to dramatically decrease for the ACO model to be truly effective in controlling costs and improving quality. It was also noted that smaller practices seem to experience both the benefits and the drawbacks of joining an ACO more acutely than larger practices do.


Providers will need to weigh these potential pros and cons before deciding whether to enter an ACO arrangement. For their part, ACO leaders, the authors say, “may benefit from learning about the resources that physicians expect to have access to as a member of an ACO and areas in that interaction that may need attention going forward.”

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


R. A. Berenson, R. A. Burton, and M. McGrath, "Do Accountable Care Organizations (ACOs) Help or Hinder Primary Care Physicians’ Ability to Deliver High-Quality Care?" Healthcare, Sept. 2016 4(3):155–59.